HARRISBURG, JANUARY 26, 2023 – The Pennsylvania Pharmacists Care Network (PPCN) and Highmark Wholecare have launched a new program that allows PPCN participating pharmacies to be reimbursed for providing direct patient care services for Medicaid members across 27 counties of Pennsylvania. These services were thoughtfully designed to expand access to pharmacist-provided services, address gaps in care and cater to each individual patient’s needs.
With this new program, that targets medication adherence and address gaps in care, pharmacies are now eligible for reimbursement for services provided to eligible Highmark Wholecare Medicaid members. Examples of new covered services include: medication reconciliation, home visits, social determinants of health screenings and referrals, COVID-19 vaccine gaps closures, health risk assessments, and naloxone education and dispensing.
“Our pharmacists are thrilled for the opportunity to engage their patients with complex medication and non-medication related needs, and work collaboratively on a solution,” said Stephanie McGrath, PharmD, PPCN Executive Director and Director of Community Pharmacy Partnerships, University of Pittsburgh School of Pharmacy. “Studies have shown that Medicaid patients visit their pharmacy up to 35 times a year. These are critical opportunities for engagement and connection back to health plan and community resources. This program allows our pharmacists to provide Highmark Wholecare Medicaid members access to triage and care, in a sustainable way.”
“Highmark Wholecare believes in caring for the whole person in communities where the need is greatest,” said Jeramie Thomas, PharmD, Clinical Programs Development, Highmark Wholecare. “We look forward to supporting the type of whole health care that our members require to live their best lives. This partnership will create new pathways to identify member needs, especially ones related to social determinants of health, and strengthen our alliance with community pharmacists to improve the quality of care that we provide our members.”
Highmark Wholecare serves Blue Shield members in 13 counties in central Pennsylvania, and Blue Cross Blue Shield members in 14 counties in southwestern Pennsylvania.
About the Pennsylvania Pharmacists Care Network
The Pennsylvania Pharmacists Care Network (PPCN), a CPESN® USA network, is a clinically integrated network of over 180 community pharmacies in Pennsylvania that provide enhanced patient care services and work to advance community-based pharmacy practice. In collaboration with payors and providers, PPCN Pharmacists provide high quality medication management services to patients ensuring appropriate medication use and improved health outcomes. PPCN is a service of the Pennsylvania Pharmacists Association (PPA), the state’s leading voice for advocating for the profession of pharmacy and advancing the quality of patient care.
About CPESN® USA
CPESN® USA is a clinically integrated, nationwide organization of pharmacy networks organized to advance community-based pharmacy practice. CPESN® Networks empower community-based pharmacies that are deeply rooted within their community by fostering their ability to provide high quality, patient-centered enhanced services. CPESN® pharmacies integrate with the other providers on the patient’s care team and coordinate medical treatment which has led to better medication adherence, higher patient satisfaction, and lower healthcare costs. You can now find CPESN® Networks of pharmacy providers in 42 states across America. To learn more, please visit www.cpesn.com.
About Highmark Wholecare
We believe in caring for the whole person in all communities where the need is greatest. We see a future in which everyone has equal opportunity to achieve their best health. Through our leading Medicaid and Medicare programs, we are coordinating health care that goes beyond doctors and medicine that helps members achieve not just physical health, but also delivers whole person care. Our team members are helping to drive this new kind of health care for our 410,000 Medicaid and Medicare members in collaboration with a network of 29,000 primary care physicians, specialists, hospitals and other ancillary providers. We are also committed to supporting our neighbors through our many community outreach and engagement programs.
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